1871889964 NPI number — HOLISTIC CARE HOSPICE OF JACKSON LLC

Table of content: (NPI 1871889964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871889964 NPI number — HOLISTIC CARE HOSPICE OF JACKSON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC CARE HOSPICE OF JACKSON LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871889964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 720681
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRAM
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39272-0681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-346-7737
Provider Business Mailing Address Fax Number:
601-346-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1757 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39204-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-346-7737
Provider Business Practice Location Address Fax Number:
601-346-6333
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NOBLE
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
601-985-7291

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com